Health Questions and Answers

Question: How is the diagnosis of recurrent yeast established? How is it treated?

Answer:

There is no precise definition of what constitutes recurrent yeast infections. Most clinicians initiate a work-up for a woman who has multiple infections over the course of a year. It is important to definitively establish the cause of the symptoms. Because different forms of vaginitis can have similar symptoms, patient history and a pattern of self-treatment with over-the-counter antifungals are insufficient to establish the diagnosis of recurrent yeast. Confirm the diagnosis through office evaluation, and also evaluate patients for diabetes and HIV infection, both of which can lead to recurrent yeast infecions. Check for pregnancy, since yeast infections are more common in pregnancy.
There are a number of treatment regimens for recurrent yeast. The condition is thought to be caused by colonization of the gastrointestinal tract, which serves as a repository, leading to recurrent vaginal infections. Therefore, treatment is aimed at eradicating the yeast systemically through long courses of oral antifungals (fluconazole or ketoconazole). However, vaginal application of agents (boric acid, gentian violet) is also effective.

Reference: Stenchever MA, Droegemueller W, Herbst AL, Mishell DR (eds): Comprehensive Gynecology, 4th ed. St. Louis, Mosby, 2001.

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